Study: Coverage Would Plummet with Montana Medicaid Changes

The draft of a bill sponsored by Republican Rep. Ed Buttrey called for adding work requirements, increasing premiums and making other changes to the program that enrolls about 95,000 low-income adults.

An analysis of those changes was commissioned by the nonpartisan Montana Healthcare Foundation and conducted by the Center for Health Policy Research at George Washington University based in part on the effects of work requirements in Arkansas and Kentucky.

The analysis estimates between 31,000 and 43,000 Montanans would lose Medicaid expansion coverage due to work requirements and premium increases, with the bulk being due to the work and associated reporting requirements.

The state’s administrative costs would rise due to tracking whether enrollees are meeting work requirements or have an exemption.

“Given the lack of evidence that work requirements improve employment or income and the abundant evidence that they cause low-income people to lose benefits, the evidence indicates that Medicaid work requirements create more harm than good,” the report concluded.

A court has overturned Kentucky’s work requirement over concerns that large numbers of people could lose their coverage, while the Arkansas work requirement is being challenged, the report noted.

The expected coverage losses based on the initial draft of Buttrey’s bill would be felt especially hard in rural Montana where there are fewer options for work or community service, people may not have internet access to report their work hours, and rural hospitals are less able to absorb the costs of uncompensated care, the Democrats argue.

“We already have a successful bipartisan approach to Medicaid expansion that ensures healthy people are finding and keeping good jobs,” Gov. Steve Bullock said in a statement. “It doesn’t make sense to me that we would abandon this approach, all to spend more money, kick up to 43,000 Montanans off their coverage and hurt rural hospitals.”

Montana’s Medicaid expansion program includes a voluntary work training program that has been so successful that Maine dropped planned work requirements and is shifting to a voluntary system, the report said.

Democratic Rep. Mary Caferro, who is sponsoring a bill to continue the current Medicaid expansion program, said 96 percent of those covered are working or meet one of the exemptions by going to school, being a caregiver to a young or disabled family member, or have disabilities themselves.

“I said all along, and now we have the evidence, the work requirements really do result in people losing their health insurance and result in worse health outcomes,” Caferro said. “We’d go back to the old way of doing things and that’s accessing care when it’s too late. And my question is, the question for Rep. Buttrey, is why?”

Buttrey said Wednesday his bill has changed from the draft on which the analysis was based, but did not say how. He said he’d be more interested in a study of the impacts of his bill when it is released. He said he’s consulted with the governor on his proposal.

“I think we’re finally at the point where we disagree on these items and we agree on these items and so that’s what it’s going to be,” Buttrey said. “That means there’s been a lot of changes.”

Caferro and Buttrey say they expect both bills will be heard in a committee hearing on March 9.